Objective To explore the effect of Transtheoretical Model (TTM) health education combined with therapeutic communication on hope level and negative emotions in adolescent patients with acne. Methods A total of 98 adolescent patients with acne admitted to Guangzhou Dermatology Hospital from January 2024 to December 2025 were selected as the research subjects. According to the random number table method, they were divided into the control group and the study group, with 49 patients in each group. The control group received conventional nursing, and the study group was additionally intervened with TTM health education combined with therapeutic communication. The negative emotions, hope level, healthy lifestyle and nursing efficacy were compared between the two groups. Results Compared with the control group, the negative emotion (SAS, SDS) scores of the study group after intervention were lower, and the Herth Hope Index (HHI) and Health-Promoting Lifestyle Profile-Ⅱ (HPLP-Ⅱ) scores were higher (P <0.05). The total nursing effective rate of the study group (95.92%) was higher than that of the control group (81.63%) (P <0.05). Conclusion TTM health education combined with therapeutic communication can alleviate negative emotions of adolescent patients with acne, improve hope level, promote the development of healthy living habits, and improve the intervention effect.